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CHAPTER 48 / Nursing Care of Women with Reproductive Disorders 1587

NURSING CARE OF THE WOMAN HAVING A MASTECTOMY

NURSING RESPONSIBILITIES • Lying on one’s back or on the side not operated on helps fluid
• Ensure that the woman or family member signs informed drain from the site.
consent form. • Moving the arm on the operated side helps regain mobility;
• See Chapter 7 for preoperative preparation. specific exercises will be prescribed for increasing mobility
after the incisions have healed.
Client and Family Teaching • If fluid builds up after the drains have been removed, it can
• Deep-breathing exercises are important because after general be aspirated by the surgeon.
anesthesia, it is difficult for air to reach the lungs, particularly • Use caution about lifting heavy objects with the arm on the
with the restrictive surgical dressing that decreases chest ex- operated side.
pansion. • Be careful about injury and infection on the affected side;
• A suction apparatus will be placed in the wound to allow wear rubber gloves when washing dishes, garden gloves
drainage of excess body fluids that accumulate when the when working outside. Request that caregivers not perform
lymph nodes are removed. This device is usually removed 3 to blood pressures or venipunctures on the operative side to
5 days after surgery. reduce the risk of injury and infection.
• An IV line may be in place for fluid replacement and antibi- • Feelings of anxiety, sadness, and fear of looking at the incision
otics to reduce the risk of postoperative infection. are normal; mastectomy means abrupt change in body image.
• Control pain by using the patient-controlled analgesia device It is normal to mourn the loss of a breast and to fear the loss
or requesting analgesics before pain becomes severe. Take of one’s life after a cancer diagnosis.
analgesics as needed before performing recommended exer- • Sexual intimacy can be affected by mastectomy; it often helps
cises to facilitate full movement. to be able to discuss potential sexual problems with one’s
• Note any signs of bleeding on the dressing or on the bedding. partner, with a counselor, or with a breast cancer support
• Numbness or feelings of “pins and needles” in the axillary area group.
are common.

recurrence or metastasis. If a tumor is unusually large, radia- A new experimental radiation treatment (intraoperative ra-
tion may be used to shrink the tumor prior to surgery. Radia- diotherapy) is provided by a single, concentrated dose of radi-
tion therapy is most commonly used in combination with ation. During surgery, a probe is inserted into the cavity created
lumpectomy for early stage (I or II) breast cancer. Palliative ra- by the lumpectomy and radiation equivalent to 6 weeks of
diation therapy is also used to treat chest wall recurrences and doses is emitted for about 25 minutes. If this proves successful,
some bone metastases to help control pain and prevent frac- the treatment could make lumpectomy available to more
tures. Radiation therapy is administered by means of an women and prevent the woman from having 6 weeks of daily
external-beam or tissue implants (see Chapter 10). radiation treatments following surgery.

A Implant B Latissimus dorsi musculocutaneous flap

Figure 48–12 ■ Types of breast reconstruction surgeries. A, A breast implant is inserted under the pectoris muscle. B, Autogenous pro-
cedures transfer a flap of skin, muscle, and fat from the donor site on the woman’s body to the mastectomy site. The most frequently used
donor muscle sites are the latissimus dorsi and the rectus abdominis (the TRAM-flap or transrectus abdominis muscle flap).